Impact of Disparities in Food Security on Glycemic Control and Health Care Utilization Among Youth and Young Adults with Diabetes

粮食安全差异对青少年糖尿病患者的血糖控制和医疗保健利用的影响

• 批准号: 10512079
• 负责人: ANGELA D LIESE
• 金额: $ 1.77万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10512079
• 关键词: Acute; Address; Affect; Ancillary Study; Behavior; Behavioral; Biometry; Buffers; Caring; Centers for Disease Control and Prevention (U.S.); Child; Childhood; Chronic; Cohort Studies; Cost efficiency; Cross-Sectional Studies; Data; Data Collection; Data Security; Diabetes Mellitus; Diabetic Diet; Diabetic Ketoacidosis; Diagnosis; Disadvantaged; Disadvantaged minority; Elderly; Endocrinology; Epidemiology; Ethnic Origin; Food; Frequencies; Funding; Future; Glycosylated hemoglobin A; Goals; Health; Health Care Costs; Health behavior; High Prevalence; Hispanic; Hospitalization; Household; Hypoglycemia; Individual; Insulin-Dependent Diabetes Mellitus; Intervention; Lead; Light; Longitudinal Studies; Mediating; Medical; Medicine; Mental Health; Minority; Modeling; Monitor; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Nutrition Therapy; Nutritional; Nutritive Value; Outcome; Pathway interactions; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Physical activity; Policies; Population; Population Heterogeneity; Premature Mortality; Prevention; Psychology; Race; Recommendation; Research; Resources; Risk; Role; SEARCH for Diabetes in Youth; Self Management; Site; Time; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Work; Youth; adverse outcome; aged; clinical practice; clinically relevant; cost; design; diabetes management; ethnic diversity; ethnic minority; experience; food insecurity; food security; glucose monitor; glycemic control; health care service utilization; health economics; minority children; non-diabetic; physical conditioning; prevent; prospective; racial and ethnic; routine care; screening; social health determinants; type I and type II diabetes; virtual; young adult

PROJECT SUMMARY / ABSTRACT Despite recent advances in therapy, far too many youth and young adults (YYAs) with type 1 diabetes (T1D) and type 2 diabetes (T2D), particularly those of minority race/ethnicity, do not achieve optimal glycemic control thus placing them at increased risk of acute and chronic complications. Among the social determinants of health, household food insecurity (HFI) may be a key barrier to achieving glycemic control and may lead to increased health care utilization and costs, but virtually all of the limited research was cross-sectional and conducted in older adults with T2D. Moreover, racial/ethnic minorities are disproportionately affected by HFI, which may underlie similar disparities in diabetes outcomes. Our preliminary work suggests that HFI is a common phenomenon in YYAs with diabetes, affecting 19% of YYAs with T1D and 38% of those with T2D. These rates significantly exceed the 2015 national estimate of 12.7%. We propose a longitudinal study, the SEARCH Food Security (SFS) cohort study, which is designed as an ancillary study to the ongoing CDC/DDT- and NIH/NIDDK-funded SEARCH for Diabetes in Youth 4 study, a racially/ethnically diverse study of diabetes diagnosed in youth. The aims of the SFS study are to: (1) Initiate a food insecurity cohort study of 1,187 YYAs aged 15-35 years (53% minority) with T1D and T2D by adding two data collection time points to the ongoing SEARCH 4 study; (2) Prospectively evaluate the influence of HFI on changes in glycemic control in YYAs with T1D and T2D; (3) Quantify the mediating role of nutritional, mental health, and behavioral pathways through which food insecurity may affect changes in glycemic control in YYAs with T1D and T2D; and (4) Prospectively evaluate the influence of HFI on changes in health care utilization and medical and non-medical health care costs in YYAs with T1D and T2D. Using the SFS data in tandem with extensive data collected by SEARCH will be highly efficient for addressing these aims. The proposed study will be the first cohort study to examine the impact of food insecurity on glycemic control, health care utilization, and costs among a diverse population of US YYAs with T1D and T2D. Our transdisciplinary team is led by Drs. Liese and Mendoza, recognized experts in diabetes, epidemiology, pediatric medicine, disparities, and food insecurity research, and is supported by a team comprising expertise in pediatric endocrinology, psychology, health behaviors, health economics, biostatistics, and causal inference modeling. The study has the potential to alter diabetes policy and clinical practice by establishing the need for more in-depth assessments of food insecurity among YYAs with diabetes, re-assessment of diabetes management and nutrition recommendations for food-insecure patients, and integration of food assistance resources into routine care for persons with diabetes. It will also inform the tailoring of interventions to address food insecurity, especially for minorities, in future diabetes research trials.

项目摘要 /摘要 尽管最近的治疗取得了进步，但太多的青年和年轻人（YYA）患有1型糖尿病（T1D） 和2型糖尿病（T2D），尤其是少数种族/种族的糖尿病，无法获得最佳的血糖控制 从而使它们处于急性和慢性并发症的风险增加。在社会决定因素中 健康，家庭粮食不安全（HFI）可能是实现血糖控制的关键障碍，并可能导致 增加医疗保健利用率和成本，但实际上所有有限的研究都是横断面的， 在T2D的老年人中进行。此外，种族/族裔少数民族受到HFI的影响不成比例 这可能是糖尿病结局类似差异的基础。我们的初步工作表明HFI是 糖尿病的YYA中常见现象，影响了19％的T1D YYA和38％的T2D患者。 这些利率大大超过了2015年国家估计的12.7％。我们提出了一项纵向研究， 搜索粮食安全（SFS）队列研究，该研究被设计为正在进行的CDC/DDT-的辅助研究 以及NIH/NIDDK资助的糖尿病搜索青年4研究，这是一项种族/种族多样性的糖尿病研究 在青年时期被诊断出。 SFS研究的目的是：（1）启动一项1,187个YYAS的粮食不安全队列研究 通过将两个数据收集时间点添加到正在进行 搜索4研究； （2）前瞻性评估HFI对YYAS血糖控制变化的影响 T1D和T2D; （3）量化通过营养，心理健康和行为途径的中介作用 哪种粮食不安全感可能会影响T1D和T2D YYA中血糖控制的变化； （4）前瞻性 评估HFI对医疗保健利用以及医疗和非医疗保健的影响 带有T1D和T2D的YYAS成本。使用搜索收集的大量数据，将SFS数据同时使用 在解决这些目标方面高效。拟议的研究将是第一项研究 粮食不安全对血糖控制，医疗保健利用以及成本的影响 我们的YYAS与T1D和T2D。我们的跨学科团队由Drs领导。 Liese和Mendoza，公认的专家 在糖尿病，流行病学，儿科医学，差异和粮食不安全研究中，并得到了 团队包括小儿内分泌，心理学，健康行为，健康经济学， 生物统计学和因果推理建模。该研究有可能改变糖尿病政策和临床 通过确定对糖尿病YYAS中粮食不安全的更深入评估的必要性， 对食品不安全患者的糖尿病管理和营养建议进行重新评估，以及 将食品援助资源整合到糖尿病患者的常规护理中。它也将告知 在未来的糖尿病研究试验中，针对粮食不安全的干预措施量身定制，特别是对于少数民族。